How is HIV/AIDS a human rights issue?

What is unique about HIV/AIDS?

Since the first cases of AIDS were identified in 1981, it has been recognized that:

Stigma and discrimination against people living with, affected by, and vulnerable to HIV infection are major obstacles to delivering HIV prevention, care and treatment services
HIV stigma and discrimination are often entangled with the discrimination attached to being a woman, being poor, having a different sexual orientation, engaging in sex work or drug use, or being in prison
Protection of human rights, both of those vulnerable to infection and those already infected, is not only important for individuals, but also produces positive public health results
Supportive frameworks of policy and law are essential to effective HIV responses.

As the epidemic has progressed, it has also become increasingly clear that:

National and local responses to HIV will not work without the full engagement and participation of those affected by HIV, particularly people living with HIV.
The human rights of women, young people and children must be protected if they are to avoid infection and withstand the impact of HIV.
The human rights of marginalized groups, including people who use drugs, sex workers, prisoners, and gay and bisexual men, must also be respected for the response to HIV to be effective.

By and large, human rights abuses related to HIV have not been significantly addressed in many countries. As a result, stigma and discrimination remain pervasive, and vulnerability to infection continues to be rooted in social, economic and gender inequalities. These realities contribute to the rising number of infections each year, with women, young people and marginalized groups getting infected at the fastest rates and bearing the worst impact of AIDS.

What is the link between HIV/AIDS and tuberculosis?

Tuberculosis (TB), a disease caused by the Mycobacterium tuberculosis bacterium that attacks the lungs, is a major cause of death among people living with HIV and AIDS. HIV compromises the immune system and thus increases the likelihood of TB infection, progression, and relapse. It is estimated that one-third of the 40 million people living with HIV worldwide are co-infected with TB. TB kills up to half of all people with HIV worldwide.

Unlike HIV, however, TB can be cured. Treatment with anti-TB drugs has been shown to prolong the lives of people living with HIV by at least two years. Offering TB tests and treatment to people with HIV—and vice versa—greatly increases the chances that both diseases can be controlled.

Inadequate and inconsistent treatment practices, on the other hand, can cause drug-resistant strains of TB. Multi-drug resistant tuberculosis (MDR-TB) is difficult to treat and can be fatal. The emergence of MDR-TB thus poses a grave threat not only to be people with TB, but to overall progress in the global fight against HIV and AIDS.

Why a human rights response to HIV?

When human rights inform the content of national responses to HIV, vulnerability to HIV infection is reduced and people living with HIV can live with dignity.
When human rights principles guide the process by which local and national responses are implemented, the results are responses tailored to the needs and realities of those affected. Such principles include non-discrimination, participation, inclusion, transparency and accountability.
Where States are providing comprehensive HIV prevention, care and impact mitigation programmes to all those in need, supporting vulnerable people to be able to act on the information and services they receive, and allowing the full participation of all those affected in the design and implementation of HIV programmes, they are fulfilling their HIV-related human rights obligations and mounting an effective response to HIV.
In contrast, where human rights are not respected, protected, and promoted, the risk of HIV infection is increased, people living with and affected by HIV and AIDS suffer from discrimination, and an effective response to the epidemic is often impeded.

What are AIDS-related human rights?

In order to ensure an effective response to HIV and AIDS, all people living with, affected by, and vulnerable to HIV and AIDS must have a full range of internationally-recognized human rights respected, protected, and fulfilled:

These include the right to:

Non-discrimination and equal protection on the basis of actual or perceived HIV status
Access to effective and evidence-based HIV-prevention services
Access to anti-retroviral treatment, including treatment to prevent mother-to-child transmission of HIV
Due process in the criminal justice system, particularly for groups at risk of HIV such as sex workers, people who use drugs, and men who have sex with men
Choice of one’s place of residence and migration
Seek and enjoy asylum
Medical treatment without coercion and with guarantees of privacy
Freedom of opinion and expression and the right to freely receive and impart HIV-related information
Freedom to form and participate in HIV and AIDS organizations and associations
A work environment that is respectful of HIV status
Marry and to found a family
Equal access to education, including for children affected by HIV
A standard of living adequate to maintain good health, including social security, assistance and welfare
Freedom from torture and cruel, inhuman or degrading treatment or punishment.

Human Rights and HIV/AIDS: Now More Than Ever

Ten Reasons why human rights should occupy the center of the global response to HIV/AIDS:

Universal access will never be achieved without human rights.
Gender inequality makes women more vulnerable to HIV, with women and girls now having the highest rates of infection in heavily affected countries.
The rights and needs of children and young people are largely ignored in the response to HIV, even though they are the hardest hit in many places.
The worst affected receive the least attention in national responses to HIV.
Effective HIV-prevention, treatment, and care programs are under attack.
AIDS activists risk their safety by demanding that governments provide greater access to HIV and AIDS services.
The protection of human rights is the way to protect the public’s health.
AIDS poses unique challenges and requires an exceptional response.
“Rights-based” responses to HIV are practical, and they work.
Despite much rhetoric, real action on HIV/AIDS and human rights remains lacking.

Source: Open Society Institute Law and Health Initiative, 2007. Endorsed by 24 HIV/AIDS and human rights organizations worldwide.

Did you know?

Around the world, people living with HIV and AIDS have been segregated in schools, hospitals, and prisons; refused employment; denied the right to marry; required to submit to HIV tests as a condition of entry into other countries; banished by their communities; and killed because of their HIV-positive status.
As of 2003, almost half of governments in sub-Saharan Africa had yet to adopt legislation or court rulings specifically outlawing discrimination against people living with HIV and AIDS.
As of 2003, only one-third of countries worldwide had adopted legal measures specifically outlawing discrimination against populations especially vulnerable to HIV and AIDS.
Surveys conducted in Southern Africa between 2000-2001 found that:2
- Fewer than half of respondents in Botswana would buy fresh vegetables from a shopkeeper living with HIV or AIDS
- One-third of respondents from Lesotho felt that a female teacher who is HIV-positive but not sick should not be allowed to continue teaching in school
- Approximately one-third of respondents from Namibia were secretive about a family member’s HIV status.
Surveys conducted in Central Asia between 2000-2002 found that:3
- Only 8% of respondents in Tajikistan would buy fresh vegetables from a shopkeeper living with HIV or AIDS
- 15% of respondents from Tajikistan felt that a female teacher who is HIV-positive but not sick should not be allowed to continue teaching
- In Uzbekistan, 30% of male respondents and 46% of female respondents were secretive about their family members’ HIV status.
In a study conducted in an eastern Chinese coastal city, half of participants believed that punishment was an appropriate response towards those living with HIV, over half (56%) were unwilling to be friends with HIV-positive people, and 73% thought that those living with HIV should be isolated.4
An evaluation of the implementation of the Declaration of Commitment on HIV and AIDS undertaken in 2006 in 14 countries concluded that human rights abuses of vulnerable populations continue unabated, denying them access to services and effective tools for preventing HIV infection and to life-saving AIDS drugs that will keep them alive.5
In its most recent report on the global AIDS epidemic (2006), the Joint United Nations Programme on HIV/AIDS (UNAIDS) noted that “half of countries submitting reports to UNAIDS noted the existence of policies that interfere with the accessibility and effectiveness of HIV-related measures for prevention and care.” 6

The good news

Litigation on behalf of people living with and affected by HIV has resulted in tangible court victories in numerous countries:
- In South Africa, the Constitutional Court held the government in violation of the constitution for failing to provide nevirapine to pregnant women to prevent mother-to-child transmission of HIV
- In Serbia in 2007, a woman with HIV was awarded damages from the European Court of Human Rights after she was banned from seeing her child
- In 2007, the Mexican Supreme Court ruled it was unconstitutional to ban members from the military on the grounds of their HIV status.
Legislative reform to address the human rights aspects of HIV is underway in many countries: In 2006, the Canadian HIV/AIDS Legal Network released a multi-volume model law resource on HIV and AIDS and the rights of people who use drugs, which is being used for advocacy in countries as diverse as Georgia, Indonesia, Thailand, and Ukraine.
A growing number of NGO coalitions are uniting to address the human rights aspects of HIV. These include the Observatoire de la réponse au VIH/sida au Sénégal (Watchdog of the response to HIV and AIDS in Senegal) and the AIDS and Rights Alliance of Southern Africa (ARASA). These coalitions have shown that human rights are an effective organizing principle for mobilizing civil society against AIDS.

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